Resistant Hypertension
Conditions
Keywords
resistant hypertension, isometric exercise, handgrip, wall squat, blood pressure
Brief summary
Hypertension remains the main preventable cause of cardiovascular disease (CVD) and all-cause mortality, both in Europe and globally. Resistant hypertension, a severe phenotype of hypertension, is defined as a blood pressure (BP) that remains above the management goal despite using three different antihypertensive agents of different classes at the maximum or maximum tolerated dose, or controlled BP on four or more antihypertensive medications. Hypertension remains a poorly controlled risk factor on a global scale and the prevalence of resistant hypertension is also growing - it is now estimated to be around 10-20%. At the moment, there is robust evidence establishing the antihypertensive effects of exercise. The acute reduction of BP after a single bout of exercise is known as post-exercise hypotension. In recent years, the number of investigations into the benefits of isometric exercise in the treatment of hypertension has increased, due to its ease of access and potential for use. In a recently published meta-analysis, the authors pointed to isometric exercise as the most effective type of exercise in reducing systolic and diastolic BP. Given the scarceness of data regarding the safety and efficacy of isometric exercise in individuals with resistant hypertension and since the acute response to exercise may help to identify people who respond to exercise as antihypertensive therapy, the objective of this study is to analyse the acute effect on BP levels of two different isometric exercises - isometric handgrip (IHG) and isometric wall squat (IWS), regarding safety and efficacy, in people with resistant hypertension. The aim is to analyse if isometric exercises are safe in this population, through the assessment of BP during the execution of the exercises. Besides that, the comparison of IHG and IWS with the control session and between one and another, will help to understand which form of isometric exercise is most effective and has the longest lasting impact on reducing BP. Each participant must complete an acclimatization session, in which the procedures will be explained, data will be collected and the intensity of IHG and IWS will be assessed. Subsequently, each participant must complete three randomly assigned experimental sessions: a non-exercise control session and two exercise sessions, in which they will follow the protocols currently used in the literature (IHG at 30% of Maximum Voluntary Contraction and IWS at 95% of peak Heart Rate).
Interventions
OTHERIsometric exercise
In each arm, participants will execute an isometric exercise, in which they will perform 4 repetitions of 2 minutes.
Sponsors
Aveiro University
Universidade do Porto
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
40 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Adults aged 40 to 75 years old, previously diagnosed with resistant hypertension, and on stable medication for at least 6 months.
Exclusion criteria
* People with secondary hypertension, heart failure, peripheral artery disease, atrial fibrillation, chronic obstructive pulmonary disease or renal failure; people with a cerebro-cardiovascular event in the previous 3 months; people with changes in pharmacological therapy in the previous 6 months; trained people (with regular participation (≥ 2x/week) in exercise training programs in the previous 3 months); people who have any contraindication to exercise; people with neurological and/ or orthopaedic conditions that will interfere with their participation in exercise, such as Parkinson's disease or knee osteoarthritis. Participants with low score (\<6) on the MMAS-8 will also be excluded.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Ambulatory Blood Pressure Monitoring | Blood Pressure (in mmHg) will be assessed 15 minutes after the intervention and then every 20 minutes after each intervention session (exercise sessions and control session) until 12 hours after session | Change from baseline values of Ambulatory Systolic and Dyastolic Blood Pressure Monitoring (in mmHg) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Office Blood Pressure | Systolic and Dyastolic BP will be measured immediately before the intervention session, during the exercise sessions (at 30 seconds and 90 seconds of each repetition of the handgrip and the wall squat) and 15 minutes after each intervention session | Systolic and Dyastolic blood pressure (in mmHg) will be measured using automatic oscillometric (change from baseline will be calculated) |
| Adverse Events | Adverse events that occur during the intervention sessions, immediately after the intervention sessions or until 48 hours after the exercise sessions will be recorded | Number and severity of adverse events that occur during or after exercise |
Countries
Portugal
Contacts
Primary ContactJosé Lopes, Master
Backup ContactJosé Oliveira, PhD
Outcome results
None listed